China’s Health
Transitions
{
Diseases of poverty and affluence
Tina Phillips Johnson, PhD
Saint Vincent College
October 27, 2013
Health transitions


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Medical transitions are changes in the field of
medicine.
Health transitions are changes in the health of
populations.
Comprised of:


Demographic transition: patterns of fertility and
mortality
Epidemiologic transition: patterns of disease
Health transitions shaped by:

Direct health action



Traditional and modern medicine
Medical systems
Social determinants of health



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Political stability
Economic growth
Literacy
Education
Problems with data
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Data sources are variable by time and place
Insufficient transparency
National-level focus
Skewed data

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Disease epidemics
Invasion, war, conflict
Famine
th
20 -century
China’s
demographic transition



Population tripled in 20th century
 Estimated 430 million 1900; 1.3 billion 2000
Birth and death rates dropped 1950-2000
Population policy 1970-79:



Voluntary “late, long, few” policy
Fertility rate halved from 5.2 to 2.9
Due to:


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Wang 2011
Universal education
Improved child survival
Greater gender equality
Demographics (cont.)

Skewed sex ratio

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1.06 in 1979
1.11 in 1988
1.17 in 2001
Problems?

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Trafficking of girls
Commercial sex work industry
STDs
Davin 2007
Demographics, cont.
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Aging population

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5% >65 years in 1982
7.5% >65 years in 2012
>65 expected to rise to more than 15% by 2025
Rural-urban migration

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12% urban in 1950
50% urban in 2012
Davin, 2007
Figure 3 – Age structure of China (1950, 2010, 2050)
Source:(United Nations 2011)
Epidemiologic Transition

Shifts in burden of disease

High fertility, high mortality (pre-transition)

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High fertility, low mortality (transition)

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Characterized by infectious disease
Medical advances prolong life expectancy
Low fertility, low mortality (post-transition)

Omran 1970
Increased life expectancy, medical advances,
chronic disease
Crude birth rate (‰), crude death rate (‰) and % urban
population
45
0.5
40
0.45
0.4
35
0.35
30
0.3
25
One child
policy
20
0.25
0.2
15
0.15
10
0.1
5
0.05
0
0
1950
1975
1980
Crude Birth Rate
Chen 2013
1985
1990
1995
Crude Death Rate
2000
2005
% urban population
Burden of Disease (DALYs) in world regions, 2004
(Low- and middle- income countries grouped by WHO region, 2004)
600
80
500
62
63
71
71
67
70
60
400
50
49
300
40
30
200
20
100
10
0
0
Africa
East MED
Communicable diseases
SEA
Europe
NCDs
Americas
Injuries
Western
Pacific
Life Expectancy
DALY: Disease-adjusted life year; The overall disease burden, expressed as the number of years lost due
to ill-health, disability or early death.
China’s double burden of
disease


Infectious diseases and epidemics
Chronic and man-made non-communicable diseases
Questions?
Works Cited
Chen L. China’s Exceptional Health Transitions: Overcoming the Four
Horsemen of Apocalypse. 2011.
Davin D. Marriage Migration in China and East Asia. J Contemp China.
2007;16(50):83–95.
Ho CS, Gostin LO. The Social Face of Economic Growth: China’s Health System
in Transition. JAMA. 2009;301(17):1809–11.
Liu Y, Yang G, Zeng Y, Horton R, Chen L. Policy dialogue on China’s changing
burden of disease. The Lancet. 2013;381:1961–62.
Omran, AR. The epidemiologic transition. A theory of the epidemiology of
population change. Milbank Memorial Fund Quarterly. 1970; 49.4:509-38.
Wang F. The Future of a Demographic Overachiever: Long-Term Implications of
the Demographic Transition in China. Popul Dev Rev. 2011;37
(Supplement):173–90.
Yang G, Zeng Y, Gao GF, et al. Rapid health transition in China, 1990-2010:
findings from the Global Burden of Disease Study 2010. The Lancet.
2013;381:1987–2015.